The nurse is giving discharge instructions to a patient on the medical-surgical unit. Which patient should be taught about the possibility of an overwhelming infection?
Post chemotherapy
Diagnosed with sickle cell anemia
Diagnosed with multiple myeloma
Post-splenectomy patient
The Correct Answer is D
A. While patients receiving chemotherapy are at risk for infections due to immunosuppression, the risk of overwhelming infection, particularly from encapsulated bacteria, is higher in post-splenectomy patients due to impaired immune function without the spleen.
B. Patients with sickle cell anemia are at increased risk of infections, particularly from encapsulated bacteria, due to functional asplenia or hyposplenism, but the risk of overwhelming infection is highest in post-splenectomy patients.
C. Patients with multiple myeloma are immunocompromised and at increased risk of infections, but they do not have the same risk of overwhelming infection as post- splenectomy patients.
D. Post-splenectomy patients are at highest risk of overwhelming infection due to impaired immune function resulting from the absence of the spleen, which plays a crucial role in immune surveillance and defense against encapsulated bacteria.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. While bone involvement can occur in Hodgkin lymphoma, it is not typically associated with a high risk of spontaneous pathological fractures compared to multiple myeloma.
B. Multiple myeloma is characterized by the destruction of bone tissue, leading to an increased risk of spontaneous pathological fractures.
C. Leukemia primarily affects the bone marrow and may cause bone pain but does not typically lead to spontaneous pathological fractures.
D. Hemophilia is a bleeding disorder characterized by a deficiency in clotting factors and is not directly associated with an increased risk of spontaneous pathological fractures.
Correct Answer is ["B","C","D","E","G","H"]
Explanation
A. Polycythemia (an abnormally high red blood cell count) is not typically a primary concern in dialysis patients; instead, they are more often monitored for anemia.
B. Dialysis patients often need to restrict fluid intake to prevent fluid overload, which can exacerbate edema and cause additional cardiovascular strain.
C. Daily weight monitoring is crucial for dialysis patients to track fluid balance and detect any sudden changes that might indicate fluid retention or loss.
D. Frequent oral care is important to prevent infections, particularly because dialysis patients are at increased risk due to their compromised immune systems and possible fluid restrictions, which can lead to dry mouth and other oral health issues.
E. Dialysis patients may need a modified protein intake, depending on their specific needs and the type of dialysis (hemodialysis vs. peritoneal dialysis). Protein needs can vary, so it is essential to follow the specific dietary recommendations provided by a healthcare provider.
F. Avoiding nephrotoxic substances (e.g., certain medications, contrast dyes) is critical to protect the remaining kidney function and prevent further damage.
G. A low-sodium diet helps manage blood pressure and fluid balance, reducing the risk of fluid retention and hypertension in dialysis patients.
H. Monitoring urine output is important to assess kidney function and fluid balance.
Even though dialysis takes over some kidney functions, any remaining urine output can provide valuable information about the patient's residual kidney function.
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